| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
565 |
565 |
$8K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
141 |
141 |
$2K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
72 |
72 |
$1K |
| 92015 |
Determination of refractive state |
222 |
220 |
$884.40 |
| V2020 |
Frames, purchases |
1,101 |
1,097 |
$40.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
294 |
153 |
$0.00 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
132 |
66 |
$0.00 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
30 |
26 |
$0.00 |